| NPI | 1114165784 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 2760) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 03336) |
| Enumeration Date | 2009-02-04 |
| Last Update Date | 2015-04-02 |