| NPI | 1831381334 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD6007595) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 57012375) |
| Enumeration Date | 2007-08-17 |
| Last Update Date | 2022-07-21 |