| NPI | 1295772879 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SD 5496) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 101467) |
| 207Q00000X Family Medicine (Licence: MN 47059) | |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2015-10-27 |