| NPI | 1619115250 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60173953) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA ML 60020168) |
| Enumeration Date | 2009-02-03 |
| Last Update Date | 2018-08-30 |