| NPI | 1013999127 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 60 234573) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: NY 234573) |
| Enumeration Date | 2005-11-15 |
| Last Update Date | 2025-08-07 |