| NPI | 1205256328 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME129549) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MA10418900) |
| 207Q00000X Family Medicine (Licence: VA 0101263677) | |
| Enumeration Date | 2014-04-17 |
| Last Update Date | 2021-11-04 |