| NPI | 1356512065 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P9569) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MA08607000) |
| Enumeration Date | 2008-03-20 |
| Last Update Date | 2021-10-19 |