| NPI | 1639812530 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 74950) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 32543) |
| Enumeration Date | 2022-04-18 |
| Last Update Date | 2024-04-11 |