| NPI | 1790281723 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 89124) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME150760) |
| Enumeration Date | 2018-03-30 |
| Last Update Date | 2025-09-16 |