| NPI | 1730600834 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS020845) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT018124) |
| Enumeration Date | 2017-06-29 |
| Last Update Date | 2020-09-03 |