| NPI | 1972505402 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 242083) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD-070882-L) |
| Enumeration Date | 2005-08-15 |
| Last Update Date | 2010-07-19 |