| NPI | 1710364211 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CT 66831) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 274945) |
| Enumeration Date | 2015-05-04 |
| Last Update Date | 2026-05-13 |