| NPI | 1528502952 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: NY F340521) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: NY F340521) |
| 363L00000X Nurse Practitioner (Licence: NY 340521) | |
| Enumeration Date | 2016-12-04 |
| Last Update Date | 2020-02-14 |