| NPI | 1073997961 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS019512) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT016327) |
| Enumeration Date | 2015-07-10 |
| Last Update Date | 2018-10-12 |