| NPI | 1700880796 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ND PT13463) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SD 3638) |
| Enumeration Date | 2005-06-08 |
| Last Update Date | 2015-03-05 |