| NPI | 1679518997 |
|---|---|
| Former Name | GENEVIEVE M PETERSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301079452) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01050953) |
| Enumeration Date | 2006-06-19 |
| Last Update Date | 2011-11-21 |