| NPI | 1780689539 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 43137) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA MD-47063) |
| Enumeration Date | 2005-06-17 |
| Last Update Date | 2020-05-13 |