| NPI | 1629263397 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 198820) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CT 054752) |
| 207Q00000X Family Medicine (Licence: SC 83834) | |
| Enumeration Date | 2007-09-06 |
| Last Update Date | 2025-10-07 |