| NPI | 1194717041 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 25319) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD D0060181) |
| Enumeration Date | 2005-08-17 |
| Last Update Date | 2022-04-18 |