| NPI | 1043888746 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 77730) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND 21422) |
| 207Q00000X Family Medicine (Licence: ND RL17443) | |
| Enumeration Date | 2021-06-17 |
| Last Update Date | 2025-09-30 |