| NPI | 1982962544 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 63945) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 261963) |
| Enumeration Date | 2012-05-01 |
| Last Update Date | 2022-12-15 |