| NPI | 1104178789 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD047146L) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 271443) |
| Enumeration Date | 2012-10-08 |
| Last Update Date | 2020-03-10 |