| NPI | 1598100745 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 81048) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 72647) |
| 208D00000X General Practice (Licence: NE 28088) | |
| Enumeration Date | 2013-05-01 |
| Last Update Date | 2022-11-04 |