| NPI | 1750662813 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 65836) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 57789) |
| Enumeration Date | 2011-09-02 |
| Last Update Date | 2021-12-02 |