| NPI | 1700107554 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 270094) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 290260) |
| 207Q00000X Family Medicine (Licence: NC 2021-02681) | |
| 207Q00000X Family Medicine (Licence: TX V3100) | |
| Enumeration Date | 2010-06-16 |
| Last Update Date | 2025-04-11 |