| NPI | 1902217052 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS017899) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT015798) |
| Enumeration Date | 2014-05-12 |
| Last Update Date | 2018-09-11 |