| NPI | 1285803767 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 35290) |
| Additional Taxonomies | 302F00000X Exclusive Provider Organization (Licence: MN 35290) |
| Enumeration Date | 2008-02-28 |
| Last Update Date | 2016-06-20 |