| NPI | 1356348718 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 86734) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301069503) |
| 207Q00000X Family Medicine (Licence: OH 35-078484) | |
| Enumeration Date | 2005-06-30 |
| Last Update Date | 2023-04-20 |