| NPI | 1417252685 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: CA A68861) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: NY 243012-1) |
| Enumeration Date | 2011-01-20 |
| Last Update Date | 2011-01-20 |