| NPI | 1245618164 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD464307) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT207852) |
| Enumeration Date | 2015-05-12 |
| Last Update Date | 2021-05-12 |