| NPI | 1134358203 |
|---|---|
| Former Name | MARIA THERESA GAVIN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 264159) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2009-07-09 |
| Last Update Date | 2012-09-27 |