| NPI | 1992327621 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD61445178) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID MRM-1930) |
| Enumeration Date | 2020-05-15 |
| Last Update Date | 2023-08-24 |