| NPI | 1861496655 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 41230) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 46418) |
| Enumeration Date | 2005-06-09 |
| Last Update Date | 2015-11-06 |