| NPI | 1679524193 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | |
| Primary Taxonomy | 207PE0004X Emergency Medicine Emergency Medical Services (Licence: MN 46430) |
| Additional Taxonomies | 207PE0004X Emergency Medicine Emergency Medical Services (Licence: WI 175868) |
| 207Q00000X Family Medicine (Licence: NC 37585) | |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2023-03-07 |