| NPI | 1902968597 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D0063954) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 17691) |
| 207Q00000X Family Medicine (Licence: OH 35070582) | |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2018-04-04 |