| NPI | 1629394572 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD61217313) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SD 9947) |
| Enumeration Date | 2010-04-18 |
| Last Update Date | 2023-05-12 |