| NPI | 1619167715 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD00040848) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 17286) |
| Enumeration Date | 2007-07-26 |
| Last Update Date | 2007-07-26 |