| NPI | 1790752905 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 40933) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD00045743) |
| 207Q00000X Family Medicine (Licence: ID M9220) | |
| Enumeration Date | 2006-03-07 |
| Last Update Date | 2012-01-18 |