| NPI | 1508972159 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD00032004) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD18727) |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2022-02-04 |