| NPI | 1568614204 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP60229222) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5101017737) |
| Enumeration Date | 2008-10-14 |
| Last Update Date | 2021-11-02 |