| NPI | 1770043507 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL 1260) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 21476) |
| 261QP2300X Clinic/Center, Primary Care (Licence: FL 1260) | |
| Enumeration Date | 2019-03-20 |
| Last Update Date | 2023-12-11 |