| NPI | 1609250265 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 66340) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND 14987) |
| Enumeration Date | 2015-07-14 |
| Last Update Date | 2021-07-27 |