| NPI | 1912976952 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 50778-21) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 47631) |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2011-05-05 |