| NPI | 1598108607 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: PA MD463321) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD463321) |
| Enumeration Date | 2013-04-09 |
| Last Update Date | 2019-02-11 |