| NPI | 1104192459 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 73403-21) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 62112) |
| Enumeration Date | 2012-03-30 |
| Last Update Date | 2024-05-16 |