| NPI | 1174524821 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2013-02331) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 33949) |
| Enumeration Date | 2005-08-03 |
| Last Update Date | 2021-09-24 |