| NPI | 1508054768 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN Will Receive 2/2008) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: TN 47498) |
| Enumeration Date | 2007-10-11 |
| Last Update Date | 2020-12-14 |