| NPI | 1760061121 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: KY TP321) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34.017070) |
| 207Q00000X Family Medicine (Licence: KY TP321) | |
| Enumeration Date | 2021-04-05 |
| Last Update Date | 2025-06-04 |