| NPI | 1649314121 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA 00048760) |
| Additional Taxonomies | 208D00000X General Practice (Licence: WA 00048760) |
| Enumeration Date | 2007-02-16 |
| Last Update Date | 2014-01-24 |