| NPI | 1861648487 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60226723) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301093329) |
| Enumeration Date | 2008-08-14 |
| Last Update Date | 2020-10-09 |