| NPI | 1770717795 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 53083) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 57448) |
| Enumeration Date | 2009-05-05 |
| Last Update Date | 2025-01-23 |