| NPI | 1194011122 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: NY 276761) |
| Additional Taxonomies | 208D00000X General Practice (Licence: GA 070562) |
| Enumeration Date | 2011-06-28 |
| Last Update Date | 2024-05-15 |