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 |