| NPI | 1215136452 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 203226) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 51469) |
| 207Q00000X Family Medicine (Licence: PA MD050914L) | |
| Enumeration Date | 2007-07-17 |
| Last Update Date | 2007-07-17 |