| NPI | 1265483937 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 37677-020) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 40409) |
| 207Q00000X Family Medicine (Licence: IA 30802) | |
| 207Q00000X Family Medicine (Licence: SD 4359) | |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2007-07-08 |