| NPI | 1831453786 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 59640) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R9560) |
| Enumeration Date | 2012-06-26 |
| Last Update Date | 2021-03-09 |