| NPI | 1477940450 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 19984) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 228531-1) |
| Enumeration Date | 2015-04-17 |
| Last Update Date | 2015-10-29 |