| NPI | 1750380416 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 14564) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2009-01947) |
| Enumeration Date | 2005-07-15 |
| Last Update Date | 2025-11-05 |