| NPI | 1790480614 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 77632) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 33501) |
| Enumeration Date | 2023-03-31 |
| Last Update Date | 2024-08-08 |