| NPI | 1972955755 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA C168939) | 
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA 313320) | 
| Enumeration Date | 2016-07-06 | 
| Last Update Date | 2025-06-26 |