| NPI | 1104316058 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 65933) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 29213) |
| Enumeration Date | 2018-05-16 |
| Last Update Date | 2022-08-08 |