| NPI | 1083108401 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 63631) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT216298) |
| Enumeration Date | 2018-06-19 |
| Last Update Date | 2026-03-17 |