| NPI | 1205110574 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 61289) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL TRN16834) |
| Enumeration Date | 2011-10-05 |
| Last Update Date | 2022-04-26 |