| NPI | 1174942759 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 290720) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD60771687) |
| Enumeration Date | 2014-04-10 |
| Last Update Date | 2018-03-17 |