| NPI | 1104866847 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 46487) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 1025096) |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2025-10-07 |