| NPI | 1093169682 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 62472) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 207Q0000X) |
| Enumeration Date | 2016-04-20 |
| Last Update Date | 2019-04-24 |