| NPI | 1366856569 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA 60773048) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301105225) |
| Enumeration Date | 2014-06-16 |
| Last Update Date | 2023-02-14 |