| NPI | 1912269135 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60565046) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID MRM-1248) |
| Enumeration Date | 2012-06-13 |
| Last Update Date | 2023-09-07 |