| NPI | 1467030320 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 11422) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 332856-01) |
| Enumeration Date | 2021-03-31 |
| Last Update Date | 2025-05-08 |