| NPI | 1104655091 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA SP030872) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA RN716023) |
| Enumeration Date | 2024-07-29 |
| Last Update Date | 2024-10-17 |