| NPI | 1790121796 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2015-02035) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 191485) |
| Enumeration Date | 2013-05-16 |
| Last Update Date | 2026-08-03 |