| NPI | 1114676004 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP70013176) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 13516654-1204) |
| Enumeration Date | 2022-03-20 |
| Last Update Date | 2026-07-22 |