| NPI | 1164886909 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2026-00056) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA OP60958726) |
| Enumeration Date | 2016-04-07 |
| Last Update Date | 2026-04-21 |