| NPI | 1386697365 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME110998) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 236646) |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2018-03-17 |