| NPI | 1861019788 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 05423) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0116034434) |
| Enumeration Date | 2020-06-26 |
| Last Update Date | 2023-08-03 |