| NPI | 1063730448 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 268805) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: PA MT197011) |
| 207Q00000X Family Medicine (Licence: PA MD448673) | |
| 207Q00000X Family Medicine (Licence: NM MD2013-0648) | |
| Enumeration Date | 2010-05-11 |
| Last Update Date | 2017-01-18 |