| NPI | 1619176955 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 206178-1) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 94-01201) |
| 207Q00000X Family Medicine (Licence: SC T3025) | |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: NY 206178) | |
| Enumeration Date | 2007-07-17 |
| Last Update Date | 2020-07-13 |