| NPI | 1053666081 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP60538018) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0116025188) |
| Enumeration Date | 2012-07-16 |
| Last Update Date | 2015-09-10 |