| NPI | 1164717930 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA md450859) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT200335) |
| Enumeration Date | 2011-06-09 |
| Last Update Date | 2024-10-30 |