| NPI | 1700812443 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35-050480) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301051752) |
| 208D00000X General Practice (Licence: MI 4301051752) | |
| Enumeration Date | 2006-06-24 |
| Last Update Date | 2014-05-08 |