| NPI | 1659548196 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 78528) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2010-01361) |
| Enumeration Date | 2008-05-14 |
| Last Update Date | 2025-07-21 |