| NPI | 1235512450 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60834036) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA PGY.202749) |
| Enumeration Date | 2015-07-07 |
| Last Update Date | 2020-09-11 |