| NPI | 1669730644 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60569980) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 61550) |
| Enumeration Date | 2012-04-27 |
| Last Update Date | 2025-04-03 |