| NPI | 1780977850 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 55485) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2014-01443) |
| Enumeration Date | 2011-05-24 |
| Last Update Date | 2021-09-09 |