| NPI | 1992701619 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SD 4722) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 42466) |
| Enumeration Date | 2005-06-27 |
| Last Update Date | 2023-03-07 |