| NPI | 1073545729 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 56201) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 59644) |
| 207Q00000X Family Medicine (Licence: IA 37933) | |
| 207Q00000X Family Medicine (Licence: SC TL27945) | |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2020-09-15 |