| NPI | 1750940714 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA 61658916) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT218882) |
| 207Q00000X Family Medicine (Licence: NY 319710) | |
| Enumeration Date | 2019-06-12 |
| Last Update Date | 2025-07-01 |