| NPI | 1700847340 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 42529) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 41645020) |
| Enumeration Date | 2006-03-31 |
| Last Update Date | 2012-01-04 |