| NPI | 1134231822 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 02905) |
| Additional Taxonomies | 207QA0000X Family Medicine Adolescent Medicine (Licence: KY 02905) |
| 207QA0401X Family Medicine Addiction Medicine (Licence: KY 02905) | |
| 207QA0505X Family Medicine Adult Medicine (Licence: KY 02905) | |
| 207QG0300X Family Medicine Geriatric Medicine (Licence: KY 02905) | |
| 207QS0010X Family Medicine Sports Medicine (Licence: KY 02905) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2019-04-16 |