| NPI | 1760169742 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CT 83885) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4351051798) |
| Enumeration Date | 2023-06-30 |
| Last Update Date | 2026-03-12 |