| NPI | 1871836510 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X (Licence: WA MD60773398) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: WA MD60773398) |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: WA MD60773398) | |
| Enumeration Date | 2013-04-01 |
| Last Update Date | 2020-02-04 |