| NPI | 1750360095 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2015-00957) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD038747E) |
| Enumeration Date | 2006-01-14 |
| Last Update Date | 2018-03-28 |