| NPI | 1972173417 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 83699) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2021024274) |
| Enumeration Date | 2021-06-28 |
| Last Update Date | 2026-02-18 |