| NPI | 1013979368 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL me0053709) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 277709) |
| Enumeration Date | 2006-04-03 |
| Last Update Date | 2021-10-06 |