| NPI | 1790967347 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 57592) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD438794) |
| Enumeration Date | 2007-12-05 |
| Last Update Date | 2023-03-28 |