| NPI | 1689688921 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SD LT1090) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 48727) |
| Enumeration Date | 2006-07-29 |
| Last Update Date | 2008-11-21 |