| NPI | 1376856088 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP60385329) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5101019005) |
| Enumeration Date | 2010-07-22 |
| Last Update Date | 2021-04-01 |