| NPI | 1104385988 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 318060-01) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MA11353400) |
| Enumeration Date | 2019-03-19 |
| Last Update Date | 2023-09-12 |