| NPI | 1477794766 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 52305) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 00243361) |
| 207Q00000X Family Medicine (Licence: MN temp 104315) | |
| Enumeration Date | 2009-03-16 |
| Last Update Date | 2022-03-29 |