| NPI | 1902420458 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS021775) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT020278) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH OT020278) | |
| Enumeration Date | 2020-06-01 |
| Last Update Date | 2025-04-10 |