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 |