| NPI | 1568654895 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 154439-1) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VT 042-0009606) |
| Enumeration Date | 2007-08-10 |
| Last Update Date | 2007-08-10 |