| NPI | 1477993525 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 49305) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301103219) |
| Enumeration Date | 2013-07-02 |
| Last Update Date | 2020-03-24 |