| NPI | 1790009454 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WY 11180A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 54338) |
| Enumeration Date | 2010-03-23 |
| Last Update Date | 2021-01-21 |