| NPI | 1811445331 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: WA MD61041205) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD61041205) |
| Enumeration Date | 2016-09-13 |
| Last Update Date | 2025-12-08 |