| NPI | 1679818470 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC VL 47)  | 
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ 25MA03621700)  | 
| Enumeration Date | 2012-12-05 | 
| Last Update Date | 2012-12-05 |