| NPI | 1083630826 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60767737) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 49472) |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2021-06-21 |