| NPI | 1346700978 |
|---|---|
| Former Name | ASHLEY NICOLE KOONTZ |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: NC 336334) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS023122) |
| Enumeration Date | 2019-03-20 |
| Last Update Date | 2026-06-04 |