| NPI | 1568558054 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 51394-020) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA 60080588) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2014-10-10 |