| NPI | 1700264405 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 294145) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 1014330) |
| Enumeration Date | 2015-05-13 |
| Last Update Date | 2023-07-24 |