| NPI | 1942881412 |
|---|---|
| Former Name | LAURA MCKENZIE PETERSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 72446) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 84025) |
| Enumeration Date | 2021-04-16 |
| Last Update Date | 2024-11-15 |