| NPI | 1710971775 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 43386) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101235403) |
| Enumeration Date | 2005-09-07 |
| Last Update Date | 2010-11-12 |