| NPI | 1093708505 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 45023020) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 44896) |
| Enumeration Date | 2005-08-30 |
| Last Update Date | 2019-09-12 |