| NPI | 1982924619 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 62301) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35-120250) |
| Enumeration Date | 2010-06-04 |
| Last Update Date | 2021-03-10 |