| NPI | 1740777192 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 309828) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 309828) |
| Enumeration Date | 2018-04-20 |
| Last Update Date | 2023-07-07 |