| NPI | 1104974039 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 303704) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A85071) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2022-05-23 |