| NPI | 1376862615 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 224262-1) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD057982L) |
| Enumeration Date | 2010-05-26 |
| Last Update Date | 2010-05-26 |