| NPI | 1376172213 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 80974) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 8402) |
| 207Q00000X Family Medicine (Licence: WI 76396) | |
| Enumeration Date | 2020-04-03 |
| Last Update Date | 2026-04-30 |