| NPI | 1790897379 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301076163) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MA07613000) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2015-05-08 |