| NPI | 1912387267 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OT016720) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2018-01901) |
| Enumeration Date | 2015-06-02 |
| Last Update Date | 2022-06-07 |