| NPI | 1790071371 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101271933) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 313116) |
| 207Q00000X Family Medicine (Licence: PA MT200470) | |
| 207Q00000X Family Medicine (Licence: CT 52717) | |
| Enumeration Date | 2011-06-22 |
| Last Update Date | 2025-02-12 |