| NPI | 1063504207 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 35785) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01053156A) |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2018-04-19 |