| NPI | 1255565990 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036121954) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 54207-020) |
| 207Q00000X Family Medicine (Licence: CA A114049) | |
| 207Q00000X Family Medicine (Licence: NJ 25MA09568100) | |
| Enumeration Date | 2009-05-10 |
| Last Update Date | 2016-12-05 |