| NPI | 1053672865 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MA09937300) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD458145) |
| 207Q00000X Family Medicine (Licence: VA 0116024439) | |
| Enumeration Date | 2012-06-07 |
| Last Update Date | 2022-03-30 |