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 |