| NPI | 1720183254 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 043278) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME131905) |
| 207Q00000X Family Medicine (Licence: PA MD464175) | |
| 207Q00000X Family Medicine (Licence: OH 35.135432) | |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2021-10-26 |