| NPI | 1124321690 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MA08590600) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: HI MD10210) |
| Enumeration Date | 2010-12-06 |
| Last Update Date | 2012-01-05 |