| NPI | 1992070205 |
|---|---|
| Former Name | MELODY MARIE ROTH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 26513) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125.061226) |
| Enumeration Date | 2012-03-20 |
| Last Update Date | 2018-02-06 |