| NPI | 1215972021 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME 113991) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35076625T) |
| Enumeration Date | 2006-06-17 |
| Last Update Date | 2024-02-15 |