| NPI | 1912312034 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD183053) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD60656713) |
| Enumeration Date | 2014-06-26 |
| Last Update Date | 2022-02-04 |