| NPI | 1659366060 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME86524) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 226224) |
| Enumeration Date | 2005-09-13 |
| Last Update Date | 2015-06-19 |