| NPI | 1770717639 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 58722) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 25740) |
| 207Q00000X Family Medicine (Licence: WI 54824) | |
| Enumeration Date | 2009-05-07 |
| Last Update Date | 2015-06-02 |