| NPI | 1427405224 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 04709) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5101022382) |
| 207Q00000X Family Medicine (Licence: NE 2055) | |
| Enumeration Date | 2016-05-21 |
| Last Update Date | 2020-08-04 |