| NPI | 1568721538 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301110961) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 280303) |
| Enumeration Date | 2012-05-11 |
| Last Update Date | 2020-02-12 |