| NPI | 1376283697 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: WA MD.MD.61674705) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CO 0072158) |
| 208D00000X General Practice (Licence: CO DR.0072158) | |
| Enumeration Date | 2022-04-01 |
| Last Update Date | 2025-08-28 |