| NPI | 1114399474 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 04945) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 58.007308) |
| 207Q00000X Family Medicine (Licence: KY TP870) | |
| Enumeration Date | 2015-10-27 |
| Last Update Date | 2022-05-20 |