| NPI | 1013470509 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 68703) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 66177) |
| Enumeration Date | 2019-04-10 |
| Last Update Date | 2025-08-26 |