| NPI | 1104453463 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR DO217449) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34.016306) |
| Enumeration Date | 2020-03-26 |
| Last Update Date | 2024-09-06 |