| NPI | 1902888639 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 46146) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD00045501) |
| Enumeration Date | 2005-11-17 |
| Last Update Date | 2020-08-21 |