| NPI | 1740803667 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID 5071060) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: MA E0917113) |
| Enumeration Date | 2020-05-27 |
| Last Update Date | 2025-07-24 |