| NPI | 1124777461 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MT224880) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 105514) |
| Enumeration Date | 2022-03-23 |
| Last Update Date | 2025-09-10 |