| NPI | 1790309508 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 81205) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-11880) |
| Enumeration Date | 2020-06-08 |
| Last Update Date | 2023-11-14 |