| NPI | 1114285905 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: MA 265139) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care (Licence: MA 265139) |
| 314000000X Skilled Nursing Facility (Licence: MA 265139) | |
| Enumeration Date | 2012-04-30 |
| Last Update Date | 2021-08-12 |