| NPI | 1093542110 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV APRN120792) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA SP030143) |
| Enumeration Date | 2024-09-14 |
| Last Update Date | 2024-10-08 |