| NPI | 1063704674 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 46715) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY R2614) |
| 207Q00000X Family Medicine (Licence: KY TP423) | |
| Enumeration Date | 2011-05-15 |
| Last Update Date | 2014-06-23 |