| NPI | 1780200592 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID O-1885) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2025042217) |
| Enumeration Date | 2020-06-18 |
| Last Update Date | 2025-10-16 |