| NPI | 1154341782 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 40878) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL40878) |
| 363A00000X Physician Assistant (Licence: ND PAC0350) | |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2020-07-24 |