| NPI | 1528553997 |
|---|---|
| Former Name | CHARLOTTE MEDLOCK WERTZ |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 83760) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT018844) |
| Enumeration Date | 2018-06-27 |
| Last Update Date | 2021-12-03 |