| NPI | 1871889360 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60893831) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2011017316) |
| Enumeration Date | 2011-06-22 |
| Last Update Date | 2021-04-05 |