| NPI | 1619910528 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: MN 43849) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA 20A25318) |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2026-05-19 |