| NPI | 1639664519 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2023-02012) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT018786) |
| 207Q00000X Family Medicine (Licence: AZ 009114) | |
| Enumeration Date | 2018-06-25 |
| Last Update Date | 2023-10-13 |