| NPI | 1104867084 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 70858) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 225730) |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2022-08-09 |