| NPI | 1134611551 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 309898-01) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0102208260) |
| Enumeration Date | 2018-06-01 |
| Last Update Date | 2026-08-04 |