| NPI | 1679839302 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP60531519) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A 12442) |
| Enumeration Date | 2012-04-06 |
| Last Update Date | 2016-02-09 |