| NPI | 1629246376 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 240549) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ME142413) |
| Enumeration Date | 2008-02-15 |
| Last Update Date | 2025-09-05 |