| NPI | 1205910841 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 21125) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2005-01454) |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2021-11-17 |