| NPI | 1265595524 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME99422) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 190386) |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2016-02-04 |