| NPI | 1093367294 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 344497) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: NY 344497) |
| Enumeration Date | 2019-07-09 |
| Last Update Date | 2019-07-09 |