| NPI | 1407062045 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.126514) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301088430) |
| 207Q00000X Family Medicine (Licence: IL 036.124871) | |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2015-06-25 |