| NPI | 1962642843 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60042947) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO Tl2243) |
| Enumeration Date | 2009-03-04 |
| Last Update Date | 2014-01-06 |