| NPI | 1629067939 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.087368) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME 015865) |
| Enumeration Date | 2005-10-19 |
| Last Update Date | 2011-01-31 |