| NPI | 1134765910 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP61418444) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID O-1565) |
| Enumeration Date | 2019-11-26 |
| Last Update Date | 2025-07-28 |