| NPI | 1922590629 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 9191) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT018400) |
| Enumeration Date | 2018-05-30 |
| Last Update Date | 2022-06-16 |