| NPI | 1265693980 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301092741) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35.097162) |
| Enumeration Date | 2008-06-25 |
| Last Update Date | 2012-11-30 |