| NPI | 1639175557 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL 77389) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD058789L) |
| Enumeration Date | 2005-06-24 |
| Last Update Date | 2019-09-03 |