| NPI | 1679862726 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD61183962) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD206005) |
| Enumeration Date | 2011-03-29 |
| Last Update Date | 2026-01-22 |