| NPI | 1679150882 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MT MED-PHYS-LIC-161588) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA OP61519931) |
| Enumeration Date | 2021-03-24 |
| Last Update Date | 2025-09-10 |