| NPI | 1609190560 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 85750) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 270703) |
| Enumeration Date | 2010-03-22 |
| Last Update Date | 2025-10-08 |