| NPI | 1164605374 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 51230) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 19685) |
| Enumeration Date | 2007-12-11 |
| Last Update Date | 2020-09-22 |