| NPI | 1982630679 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35-098748) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101233433) |
| Enumeration Date | 2006-06-24 |
| Last Update Date | 2013-10-21 |