| NPI | 1629035308 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 38922) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301086765) |
| 207Q00000X Family Medicine (Licence: WI 38751-020) | |
| 207Q00000X Family Medicine (Licence: WI 38751-20) | |
| Enumeration Date | 2006-04-27 |
| Last Update Date | 2017-05-09 |