| NPI | 1013966795 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AK MEDS4174) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 26259) |
| Enumeration Date | 2006-05-09 |
| Last Update Date | 2025-01-27 |