| NPI | 1770999310 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 05-40915) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT015918) |
| Enumeration Date | 2014-07-03 |
| Last Update Date | 2019-08-19 |