| NPI | 1215151634 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME 64301) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 188378) |
| Enumeration Date | 2007-04-13 |
| Last Update Date | 2007-07-08 |