| NPI | 1215374640 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102205209) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT015048) |
| Enumeration Date | 2013-05-24 |
| Last Update Date | 2021-06-01 |