| NPI | 1699126300 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 68356) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME EC161062) |
| 207Q00000X Family Medicine (Licence: WI 74282) | |
| 207Q00000X Family Medicine (Licence: MI 4301117159) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: MN 68356) | |
| Enumeration Date | 2016-06-23 |
| Last Update Date | 2020-11-05 |