| NPI | 1720090806 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR 27203) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 48541) |
| Enumeration Date | 2006-08-13 |
| Last Update Date | 2017-09-07 |