| NPI | 1710111505 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 73194) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 55449) |
| Enumeration Date | 2009-05-07 |
| Last Update Date | 2024-02-28 |