| NPI | 1790191732 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 62703) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-10115) |
| Enumeration Date | 2014-07-10 |
| Last Update Date | 2020-12-21 |