| NPI | 1558829150 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD226849) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD61156196) |
| Enumeration Date | 2019-03-04 |
| Last Update Date | 2025-12-03 |