| NPI | 1790715217 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 39307) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35085814) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2018-04-29 |