| NPI | 1013052604 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 25650) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01049466A) |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2012-10-15 |