| NPI | 1679951396 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MT MED-PHYS-LIC-97779) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 296030) |
| Enumeration Date | 2015-05-14 |
| Last Update Date | 2025-04-09 |