| NPI | 1770849994 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 282743) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 58873) |
| Enumeration Date | 2012-04-02 |
| Last Update Date | 2016-01-25 |