| NPI | 1033604897 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 30434) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 7001003H) |
| Enumeration Date | 2018-06-25 |
| Last Update Date | 2021-12-15 |