| NPI | 1700379187 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS020918) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT018524) |
| Enumeration Date | 2018-06-11 |
| Last Update Date | 2021-10-13 |