| NPI | 1104262674 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.134487) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01079135A) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: OH 35.134487) | |
| Enumeration Date | 2013-05-10 |
| Last Update Date | 2025-08-18 |