| NPI | 1689613564 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY BA9939250) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MA079357200) |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2013-05-02 |