| NPI | 1861703654 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 070328) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA Mt198297) |
| Enumeration Date | 2010-06-25 |
| Last Update Date | 2016-08-02 |