| NPI | 1457493694 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: NY 264188) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 264188) |
| 208D00000X General Practice (Licence: NJ 25MB10756500) | |
| 208D00000X General Practice (Licence: FL 16878) | |
| 208D00000X General Practice (Licence: CA 18641) | |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2021-01-12 |