| NPI | 1720438674 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X (Licence: PA MT234992) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A157691) |
| Enumeration Date | 2016-06-21 |
| Last Update Date | 2025-06-18 |