| NPI | 1528478500 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 70236) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 269814) |
| Enumeration Date | 2014-04-30 |
| Last Update Date | 2022-02-24 |