| NPI | 1891134490 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OT015161) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 273010) |
| 207Q00000X Family Medicine (Licence: NH 19957) | |
| Enumeration Date | 2013-06-18 |
| Last Update Date | 2022-11-10 |