| NPI | 1912240854 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60967147) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD176129) |
| Enumeration Date | 2013-03-28 |
| Last Update Date | 2026-06-16 |