| NPI | 1508056227 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 36297) |
| 207Q00000X Family Medicine (Licence: WV 21708) | |
| Enumeration Date | 2007-07-30 |
| Last Update Date | 2007-07-30 |