| NPI | 1760862908 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 65440) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2018-01183) |
| Enumeration Date | 2015-06-03 |
| Last Update Date | 2022-07-27 |