| NPI | 1780062679 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD464672) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT208535) |
| Enumeration Date | 2015-05-11 |
| Last Update Date | 2023-11-03 |