| NPI | 1083823728 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD70020095) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301088767) |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2025-12-04 |