| NPI | 1730569369 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 302188) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-10199) |
| 207Q00000X Family Medicine (Licence: VA 0101267661) | |
| Enumeration Date | 2015-06-09 |
| Last Update Date | 2022-09-16 |