| NPI | 1518948165 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 39495) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AK 3790) |
| 207Q00000X Family Medicine (Licence: WA MD00034290) | |
| Enumeration Date | 2005-11-10 |
| Last Update Date | 2023-05-10 |