| NPI | 1245218312 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35069498) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301069273) |
| Enumeration Date | 2006-01-09 |
| Last Update Date | 2015-09-30 |