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 |