| NPI | 1063723112 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 276246-01) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125.058558) |
| Enumeration Date | 2010-06-23 |
| Last Update Date | 2024-08-09 |