| NPI | 1770769150 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60819201) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 51642) |
| Enumeration Date | 2008-01-15 |
| Last Update Date | 2018-10-08 |