NPI | 1588028153 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 261Q00000X Clinic/Center (Licence: NY 1043889967) |
Additional Taxonomies | 261QM2500X Clinic/Center, Medical Specialty (Licence: NJ 1992372403) |
261QM2500X Clinic/Center, Medical Specialty (Licence: CT 1992372403) | |
Enumeration Date | 2016-04-11 |
Last Update Date | 2024-07-16 |