| NPI | 1730149790 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 42149) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 233784) |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2017-02-22 |