| NPI | 1912960600 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine (Licence: MN 46738) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 46738) |
| Enumeration Date | 2006-04-11 |
| Last Update Date | 2021-05-28 |