| NPI | 1619257995 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MT203183) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX Q4297) |
| Enumeration Date | 2011-08-18 |
| Last Update Date | 2015-09-10 |