| NPI | 1104817212 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35-071229) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35071229P) |
| Enumeration Date | 2005-10-31 |
| Last Update Date | 2021-01-25 |