| NPI | 1629291828 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 52315-020) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA 39432) |
| 207Q00000X Family Medicine (Licence: MN 61162) | |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2016-10-12 |