| NPI | 1912344722 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 64552) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ R73927) |
| 207Q00000X Family Medicine (Licence: CO 0057264) | |
| Enumeration Date | 2013-06-03 |
| Last Update Date | 2018-10-09 |