| NPI | 1124553722 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 3557) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT017575) |
| Enumeration Date | 2017-04-21 |
| Last Update Date | 2020-07-06 |