| NPI | 1962959379 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 64135) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 27765) |
| Enumeration Date | 2016-09-01 |
| Last Update Date | 2018-07-13 |