| NPI | 1235418005 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 2634) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV ED0221A) |
| Enumeration Date | 2011-08-11 |
| Last Update Date | 2018-11-19 |