| NPI | 1861785966 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102203804) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT014231) |
| Enumeration Date | 2011-05-23 |
| Last Update Date | 2014-06-13 |