| NPI | 1104884568 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: PA MD025576E) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD025576E) |
| 207QG0300X Family Medicine Geriatric Medicine (Licence: PA MD025576E) | |
| 204R00000X Electrodiagnostic Medicine (Licence: PA MD025576E) | |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2011-04-06 |