| NPI | 1770690224 |
|---|---|
| Doing Business As | |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 45967) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 39767) |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2021-11-22 |