| NPI | 1992959720 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60248964) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 51015650) |
| Enumeration Date | 2008-11-06 |
| Last Update Date | 2012-03-08 |