| NPI | 1720177991 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA MD.201668) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 241641) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2013-02-14 |