| NPI | 1629039391 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD61565465) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD D0062275) |
| Enumeration Date | 2006-03-31 |
| Last Update Date | 2025-10-21 |