| NPI | 1245202340 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 22001) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 22687) |
| 207Q00000X Family Medicine (Licence: CA G44963) | |
| Enumeration Date | 2006-02-02 |
| Last Update Date | 2009-04-22 |