| NPI | 1649369729 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP00001622) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: WA OP00001622) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2007-07-08 |