| NPI | 1609802735 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 48512) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 13333-321) |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2026-03-25 |