| NPI | 1033195748 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301090975) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35068802G) |
| Enumeration Date | 2005-12-15 |
| Last Update Date | 2014-03-10 |