| NPI | 1962961359 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID 3571057) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA 61181074) |
| Enumeration Date | 2019-03-15 |
| Last Update Date | 2025-09-19 |