| NPI | 1972502003 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MT 11746) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD420828) |
| Enumeration Date | 2005-07-20 |
| Last Update Date | 2021-05-21 |