| NPI | 1467987768 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 56190) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY R4805) |
| 207Q00000X Family Medicine (Licence: KY TP517) | |
| Enumeration Date | 2017-04-24 |
| Last Update Date | 2022-01-03 |