| NPI | 1790786028 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M-9533) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 25517) |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2025-09-16 |