| NPI | 1760430888 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: KY 38878) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: KY 38878) |
| 208600000X Surgery (Licence: KY 38878) | |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2023-04-15 |