| NPI | 1114475837 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 19369) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT212257) |
| Enumeration Date | 2016-09-12 |
| Last Update Date | 2019-11-12 |