| NPI | 1952796591 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301507212) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD60760229) |
| Enumeration Date | 2015-03-31 |
| Last Update Date | 2022-08-19 |