| NPI | 1588628648 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35-126324) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101057897) |
| Enumeration Date | 2006-04-14 |
| Last Update Date | 2016-02-23 |