| NPI | 1629019724 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL MD.33738) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WV 19961) |
| 208000000X Pediatrics (Licence: OH 35-07-6408) | |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2019-01-09 |