| NPI | 1902256027 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 85501) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME135573) |
| 261QP2300X Clinic/Center, Primary Care (Licence: GA 85501) | |
| Enumeration Date | 2016-06-20 |
| Last Update Date | 2022-09-21 |