| NPI | 1629286430 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MT 11990) |
| Additional Taxonomies | 208D00000X General Practice (Licence: WA OP00001820) |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2019-04-10 |