| NPI | 1104236942 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 30169) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX S1613) |
| 207Q00000X Family Medicine (Licence: PA MD458848) | |
| Enumeration Date | 2014-05-01 |
| Last Update Date | 2021-10-23 |