| NPI | 1063501534 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60138693) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-7799) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2021-05-20 |