| NPI | 1710390281 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AK 120439) |
| Additional Taxonomies | 282NR1301X General Acute Care Hospital, Rural (Licence: WV WVED0418A) |
| Enumeration Date | 2014-06-03 |
| Last Update Date | 2018-03-17 |