| NPI | 1184654758 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CT 61122) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 43475) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2018-07-30 |