| NPI | 1265498133 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD469551) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 46368) |
| 2084A0401X Psychiatry & Neurology Addiction Medicine (Licence: WI 46368) | |
| Enumeration Date | 2006-04-21 |
| Last Update Date | 2020-02-11 |