| NPI | 1184837494 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2018-01651) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 57-011569) |
| 174400000X Specialist (Licence: OH 35-093882) | |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2018-08-21 |