| NPI | 1578856050 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 72143) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD452666) |
| Enumeration Date | 2011-05-17 |
| Last Update Date | 2022-09-12 |