| NPI | 1790770923 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35-098618) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 41608) |
| Enumeration Date | 2005-09-14 |
| Last Update Date | 2021-01-15 |