| 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 |