| NPI | 1861488074 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD069929L) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: PA MD069929L) |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: VA 0101250992) | |
| 207QA0505X Family Medicine, Adult Medicine (Licence: VA 0101250992) | |
| Enumeration Date | 2005-09-22 |
| Last Update Date | 2019-10-10 |