| NPI | 1619358074 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 61034) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 103081) |
| Enumeration Date | 2015-06-11 |
| Last Update Date | 2025-08-29 |