| NPI | 1912908294 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD61333641) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD066205L) |
| 207Q00000X Family Medicine (Licence: HI MD-23568) | |
| 207Q00000X Family Medicine (Licence: OR MD214868) | |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2023-09-14 |