| NPI | 1902423890 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA 00000000000000000000) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT221915) |
| Enumeration Date | 2020-06-26 |
| Last Update Date | 2020-06-26 |