| NPI | 1609497973 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 70537) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 82220-20) |
| Enumeration Date | 2020-04-28 |
| Last Update Date | 2023-09-22 |