| NPI | 1972165959 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 318240) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT019635) |
| Enumeration Date | 2019-07-01 |
| Last Update Date | 2025-05-15 |