| NPI | 1619612389 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ME DO4329) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 335847-01) |
| Enumeration Date | 2022-04-28 |
| Last Update Date | 2026-07-07 |