| NPI | 1104077635 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60082364) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR LL17705) |
| 207Q00000X Family Medicine (Licence: HI MD16546) | |
| Enumeration Date | 2008-10-02 |
| Last Update Date | 2013-08-02 |