| NPI | 1720583255 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 65836) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 29143) |
| Enumeration Date | 2018-03-27 |
| Last Update Date | 2021-10-15 |