| NPI | 1417202268 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036136306) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 265725-1) |
| 207Q00000X Family Medicine (Licence: CT 051158) | |
| Enumeration Date | 2012-07-18 |
| Last Update Date | 2020-02-17 |