| NPI | 1376073015 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 86286) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT213881) |
| Enumeration Date | 2017-06-15 |
| Last Update Date | 2021-04-01 |