| NPI | 1104496918 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL 35983) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT224095) |
| Enumeration Date | 2021-06-25 |
| Last Update Date | 2022-07-13 |