| NPI | 1225099567 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 63349) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 43568) |
| Enumeration Date | 2006-03-28 |
| Last Update Date | 2015-02-25 |