| NPI | 1891143079 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS020684) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: PA OS020684) |
| Enumeration Date | 2016-05-29 |
| Last Update Date | 2025-07-18 |