| NPI | 1710988118 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101262966) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD D85221) |
| 207Q00000X Family Medicine (Licence: PA MD039078L) | |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2023-01-31 |