| NPI | 1962147231 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ R79426) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD70010553) |
| Enumeration Date | 2022-05-02 |
| Last Update Date | 2025-07-17 |