| NPI | 1669456752 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2013-01398) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35-079379) |
| Enumeration Date | 2005-12-01 |
| Last Update Date | 2017-03-09 |