| NPI | 1114012481 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 56914) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 40024) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2020-07-23 |