| NPI | 1740591692 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: NY 218583) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA 168648) |
| Enumeration Date | 2010-06-25 |
| Last Update Date | 2026-04-06 |