| NPI | 1689636268 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME114917) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 161590) |
| Enumeration Date | 2006-04-06 |
| Last Update Date | 2019-05-10 |