| NPI | 1063625416 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MT 12049) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34.008889) |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2022-02-22 |