| NPI | 1346217130 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 43975-20) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 233457) |
| Enumeration Date | 2006-03-01 |
| Last Update Date | 2022-03-12 |