| NPI | 1629365598 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60462415) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 6422) |
| Enumeration Date | 2011-06-29 |
| Last Update Date | 2022-06-20 |