| NPI | 1861484875 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 23548) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 63197) |
| Enumeration Date | 2005-08-16 |
| Last Update Date | 2020-11-03 |