| NPI | 1104270313 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60869831) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA ML60659137) |
| Enumeration Date | 2016-04-14 |
| Last Update Date | 2019-05-31 |