| NPI | 1295820066 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QP2300X Clinic/Center Primary Care (Licence: OR OR MD15214) |
| Additional Taxonomies | 261QP2300X Clinic/Center Primary Care (Licence: WA WA MD 00034922) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2007-07-12 |