| NPI | 1205499308 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 110893) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD61224464) |
| Enumeration Date | 2019-04-16 |
| Last Update Date | 2026-03-08 |