| NPI | 1417178021 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 49880) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 55965-20) |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2019-10-24 |