| NPI | 1639385800 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 247583) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 99895) |
| 207Q00000X Family Medicine (Licence: NJ 25MA08692900) | |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2012-01-06 |