| NPI | 1790139426 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 301382) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO DR.0063553) |
| Enumeration Date | 2016-04-19 |
| Last Update Date | 2022-03-28 |