| NPI | 1821255647 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SD 8162) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 53561) |
| Enumeration Date | 2008-05-20 |
| Last Update Date | 2011-08-31 |