| NPI | 1619960002 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD19637) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD00041452) |
| Enumeration Date | 2005-08-31 |
| Last Update Date | 2021-03-09 |