| NPI | 1932513926 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WY TL3940) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ R74612) |
| Enumeration Date | 2014-06-17 |
| Last Update Date | 2022-07-21 |