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Individual
EMA AVDIC
Active
Individual
EMA AVDIC
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
OS022024
PA
207R00000X
Internal Medicine Physician
OT019061
PA
208M00000X
Hospitalist Physician
Primary
OS022024
PA
Other
Enumeration date
02/07/2015
Last updated
10/31/2024
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