| NPI | 1679955090 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 71752) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125.067538) |
| 207Q00000X Family Medicine (Licence: WI 68961) | |
| Enumeration Date | 2015-06-22 |
| Last Update Date | 2024-04-23 |