| NPI | 1255383360 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 31385) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND 5275) |
| 207Q00000X Family Medicine (Licence: ID M-5499) | |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2007-07-08 |