| NPI | 1972701472 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60173740) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID MR-0928) |
| Enumeration Date | 2007-07-05 |
| Last Update Date | 2021-03-22 |