| NPI | 1619184025 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60201818) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA 37229) |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2021-05-03 |