| NPI | 1588790794 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 42202) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: KY 42202) |
| Enumeration Date | 2007-02-24 |
| Last Update Date | 2018-09-06 |