| NPI | 1982967428 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: OH 34.012426) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV Not yet issued) |
| Enumeration Date | 2012-06-20 |
| Last Update Date | 2016-08-16 |