| NPI | 1265796494 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 56534) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 284550) |
| Enumeration Date | 2012-07-03 |
| Last Update Date | 2020-08-13 |