| NPI | 1114544020 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD61419377) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AK 212719) |
| 207Q00000X Family Medicine (Licence: WY 14931A) | |
| Enumeration Date | 2020-06-26 |
| Last Update Date | 2023-11-30 |