| NPI | 1104178961 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: WA AP61386415) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: CA 22500) |
| Enumeration Date | 2012-10-03 |
| Last Update Date | 2024-04-10 |