| NPI | 1629144498 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME96723) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ MA07148400) |
| Enumeration Date | 2006-11-25 |
| Last Update Date | 2007-12-27 |