| NPI | 1962476580 |
|---|---|
| Former Name | MARY E WUNDERLE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD29024) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301074863) |
| Enumeration Date | 2006-02-13 |
| Last Update Date | 2020-11-10 |