| NPI | 1114111879 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY TP354) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL 29968) |
| Enumeration Date | 2007-09-05 |
| Last Update Date | 2024-01-30 |