| NPI | 1114083557 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD431895) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 22967) |
| Enumeration Date | 2006-12-29 |
| Last Update Date | 2022-04-21 |