| NPI | 1801888623 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: OH 35135982) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 56172) |
| Enumeration Date | 2005-08-18 |
| Last Update Date | 2020-03-31 |