| NPI | 1639141161 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 52700) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 37915) |
| Enumeration Date | 2006-02-07 |
| Last Update Date | 2019-06-19 |