| NPI | 1679624704 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101263723) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD60181349) |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2018-09-27 |