| NPI | 1790015766 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD 60193720) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 25754) |
| Enumeration Date | 2010-01-13 |
| Last Update Date | 2020-07-30 |