| NPI | 1508503905 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 338797) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME LT25003) |
| Enumeration Date | 2022-05-17 |
| Last Update Date | 2026-02-11 |