| NPI | 1760619241 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MA09147200) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301094355) |
| Enumeration Date | 2009-06-11 |
| Last Update Date | 2021-06-09 |