| NPI | 1164168522 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.153930) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ R79462) |
| Enumeration Date | 2022-05-09 |
| Last Update Date | 2025-06-08 |