| NPI | 1679866099 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 63013) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 47356) |
| Enumeration Date | 2011-05-18 |
| Last Update Date | 2018-01-16 |