| NPI | 1477918464 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: NY 095617) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 090254) |
| Enumeration Date | 2015-12-18 |
| Last Update Date | 2021-01-05 |