| NPI | 1114128964 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 57009475) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 249074-1) |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2017-03-01 |