| NPI | 1104443126 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD70026578) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME161530) |
| Enumeration Date | 2020-06-26 |
| Last Update Date | 2026-09-10 |