| NPI | 1407151632 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 2663701) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01071585A) |
| Enumeration Date | 2011-01-19 |
| Last Update Date | 2016-10-10 |