| NPI | 1164420352 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MB07472100) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 236461) |
| Enumeration Date | 2005-07-12 |
| Last Update Date | 2018-03-30 |