| NPI | 1629481064 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD212567) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX T0697) |
| 207Q00000X Family Medicine (Licence: PA MT206313) | |
| Enumeration Date | 2014-06-03 |
| Last Update Date | 2022-11-01 |