| NPI | 1720727506 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID 7871565) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT021686) |
| Enumeration Date | 2022-06-01 |
| Last Update Date | 2025-09-04 |