| NPI | 1417294182 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: NY 281847) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: NY 281847) |
| Enumeration Date | 2013-01-14 |
| Last Update Date | 2016-03-28 |