| NPI | 1770576209 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 275152) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD D0063239) |
| 207Q00000X Family Medicine (Licence: IL 036.131224) | |
| Enumeration Date | 2005-08-30 |
| Last Update Date | 2014-10-15 |