| NPI | 1821472218 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 3413) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 58.005888) |
| Enumeration Date | 2015-07-15 |
| Last Update Date | 2020-11-13 |