| NPI | 1770143141 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 34.015970) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT019100) |
| Enumeration Date | 2019-06-18 |
| Last Update Date | 2022-07-05 |