| NPI | 1104805134 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 42021-20) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA 61062895) |
| 207Q00000X Family Medicine (Licence: AZ 59964) | |
| Enumeration Date | 2006-01-09 |
| Last Update Date | 2020-06-05 |