| NPI | 1679150114 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS22622) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 328973) |
| Enumeration Date | 2021-03-29 |
| Last Update Date | 2025-08-15 |