| NPI | 1619425717 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60767681) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 430111039) |
| Enumeration Date | 2016-09-17 |
| Last Update Date | 2023-02-01 |