| NPI | 1396803359 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 228991) |
| Additional Taxonomies | 261QU0200X Clinic/Center, Urgent Care (Licence: NY 228991) |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2019-06-19 |