| NPI | 1568026961 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP61292328) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID MRO-1822) |
| Enumeration Date | 2019-05-01 |
| Last Update Date | 2022-07-27 |