| NPI | 1780812180 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60300192) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID MR-1060) |
| Enumeration Date | 2009-06-24 |
| Last Update Date | 2021-04-30 |