| NPI | 1831164342 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 82154) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD D66570) |
| 207Q00000X Family Medicine (Licence: FL ME89130) | |
| Enumeration Date | 2006-02-18 |
| Last Update Date | 2026-06-22 |