| NPI | 1457609992 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 277051) |
| Additional Taxonomies | 207QS0010X Family Medicine Sports Medicine (Licence: NY 277051) |
| Enumeration Date | 2012-08-15 |
| Last Update Date | 2021-03-24 |