| NPI | 1710932504 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 48297) |
| Additional Taxonomies | 207QA0000X Family Medicine, Adolescent Medicine (Licence: MN 48297) |
| 207QA0505X Family Medicine, Adult Medicine (Licence: MN 48297) | |
| 207Q00000X Family Medicine (Licence: AZ 48910) | |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2017-05-08 |