| NPI | 1962595033 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME142175) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35-092361) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2021-07-01 |