| NPI | 1760774285 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA 60605790) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT014382) |
| Enumeration Date | 2011-05-03 |
| Last Update Date | 2021-03-30 |