NPI | 1871975599 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 69914) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 293513) |
Enumeration Date | 2015-06-19 |
Last Update Date | 2021-08-11 |