| NPI | 1760916324 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102207745) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 302828) |
| 282N00000X General Acute Care Hospital | |
| Enumeration Date | 2017-04-20 |
| Last Update Date | 2024-03-12 |