| NPI | 1063904696 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA DO.OP.61520884) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MT MED-PHYS-LIC-103020) |
| Enumeration Date | 2018-05-30 |
| Last Update Date | 2024-04-19 |