| NPI | 1649686528 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MT207657) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD462637) |
| 207Q00000X Family Medicine (Licence: MI 4301113132) | |
| Enumeration Date | 2014-07-11 |
| Last Update Date | 2023-06-22 |