| NPI | 1609800788 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MT 11838) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 48165) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2012-01-31 |