| NPI | 1891490744 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 82798) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 100387) |
| 207Q00000X Family Medicine (Licence: WI 81588) | |
| Enumeration Date | 2023-03-31 |
| Last Update Date | 2026-08-05 |