| NPI | 1518496611 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine (Licence: PA MD474020) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD474020) |
| Enumeration Date | 2017-06-12 |
| Last Update Date | 2023-06-15 |