| NPI | 1902854094 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 39904) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY TP381) |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2011-07-21 |