| NPI | 1255789251 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 5101026671) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 299255) |
| Enumeration Date | 2016-05-31 |
| Last Update Date | 2023-12-13 |