| NPI | 1275801219 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: NY 277201) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT205076) |
| Enumeration Date | 2011-12-06 |
| Last Update Date | 2021-03-19 |