| NPI | 1114917622 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 52259) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 46075) |
| Enumeration Date | 2005-10-26 |
| Last Update Date | 2024-05-06 |