| NPI | 1104143072 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AK 7867) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 54140) |
| Enumeration Date | 2010-04-30 |
| Last Update Date | 2015-10-14 |