| NPI | 1821381849 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA 042004) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT199390) |
| Enumeration Date | 2011-05-24 |
| Last Update Date | 2021-06-25 |