| NPI | 1679871362 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60373874) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A115165) |
| Enumeration Date | 2011-03-04 |
| Last Update Date | 2014-05-14 |