| NPI | 1730409475 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 99999) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VT 042.0018898) |
| Enumeration Date | 2010-06-04 |
| Last Update Date | 2025-10-31 |