| NPI | 1215987227 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 03296) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 231855) |
| 207Q00000X Family Medicine (Licence: SC 1103) | |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2011-04-12 |