| NPI | 1871055731 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 1024290) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA 320412) |
| Enumeration Date | 2019-04-01 |
| Last Update Date | 2025-08-11 |