| NPI | 1154308187 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 30108) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 20820) |
| Enumeration Date | 2005-12-30 |
| Last Update Date | 2020-08-14 |