| NPI | 1124551858 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 55704) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 0000063197) |
| Enumeration Date | 2017-04-10 |
| Last Update Date | 2023-08-02 |