| NPI | 1922862283 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD FO1240998) |
| Additional Taxonomies | 261QD1600X Clinic/Center, Developmental Disabilities (Licence: MD FO1240998) |
| Enumeration Date | 2024-02-07 |
| Last Update Date | 2024-02-07 |