| NPI | 1730519497 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS017286) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: PA OS017286) |
| Enumeration Date | 2013-11-17 |
| Last Update Date | 2023-09-21 |