| NPI | 1770004988 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 05105) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 3353) |
| Enumeration Date | 2017-06-28 |
| Last Update Date | 2025-03-05 |