| NPI | 1154381994 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 40292) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 21579) |
| 207Q00000X Family Medicine (Licence: FL ME140280) | |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2019-05-30 |