| NPI | 1215225404 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 61053) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 58.003952) |
| Enumeration Date | 2011-07-21 |
| Last Update Date | 2026-03-10 |