| NPI | 1891109930 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN MD58071) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301106045) |
| Enumeration Date | 2014-06-17 |
| Last Update Date | 2024-01-18 |