| NPI | 1679662712 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2022-00748) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD047711L) |
| 207Q00000X Family Medicine (Licence: NJ MA60114) | |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2022-04-11 |