| NPI | 1104277375 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP60922837) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WY 099-T1) |
| Enumeration Date | 2016-06-28 |
| Last Update Date | 2021-07-27 |