| NPI | 1619222692 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP61020077) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO DR.0053095) |
| Enumeration Date | 2012-07-17 |
| Last Update Date | 2021-08-16 |