| NPI | 1154311728 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA 33617) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 44466) |
| Enumeration Date | 2005-10-25 |
| Last Update Date | 2007-10-02 |