| NPI | 1649854712 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2024-01683) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 58.032444) |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: VA 0102209454) | |
| Enumeration Date | 2021-05-05 |
| Last Update Date | 2025-10-01 |