| NPI | 1457961054 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 336894) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 336894) |
| Enumeration Date | 2020-08-07 |
| Last Update Date | 2025-05-22 |