| NPI | 1972923258 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 78170) |
| Additional Taxonomies | 261QU0200X Clinic/Center, Urgent Care (Licence: GA 78170) |
| 207P00000X Emergency Medicine (Licence: GA 78170) | |
| Enumeration Date | 2014-04-24 |
| Last Update Date | 2026-02-04 |