| NPI | 1124751912 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 77694) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND 18744) |
| Enumeration Date | 2022-07-08 |
| Last Update Date | 2025-09-19 |