| NPI | 1073929360 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: NC 2018-00253) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NY 298161) |
| Enumeration Date | 2014-07-08 |
| Last Update Date | 2019-06-21 |