| NPI | 1780995456 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME119396) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 60252699) |
| Enumeration Date | 2010-06-28 |
| Last Update Date | 2019-02-27 |