| NPI | 1740246107 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35066409) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 17548) |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2012-09-25 |