| NPI | 1053389742 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 39579) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 26036) |
| Enumeration Date | 2006-03-09 |
| Last Update Date | 2018-03-17 |