| NPI | 1952092058 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2026005602) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 81741) |
| Enumeration Date | 2023-05-18 |
| Last Update Date | 2026-07-01 |