| NPI | 1174935720 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60893531) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: RI LP03097) |
| Enumeration Date | 2014-05-29 |
| Last Update Date | 2019-02-07 |