| NPI | 1184086621 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 52705) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY R4164) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: KY 52705) | |
| Enumeration Date | 2016-03-23 |
| Last Update Date | 2020-06-18 |