| NPI | 1902556640 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2025-00188) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NC 2025-00188) |
| Enumeration Date | 2022-03-25 |
| Last Update Date | 2025-10-27 |