| NPI | 1912649138 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 74715) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 32525) |
| Enumeration Date | 2022-04-08 |
| Last Update Date | 2023-08-03 |