| NPI | 1932511953 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60663360) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM TM2022-1101) |
| Enumeration Date | 2014-05-25 |
| Last Update Date | 2022-10-19 |