| NPI | 1972587657 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2013-00747) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35086750) |
| Enumeration Date | 2005-12-06 |
| Last Update Date | 2020-07-20 |