| NPI | 1790912426 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 292657) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CT 62179) |
| 207Q00000X Family Medicine (Licence: MA 250701) | |
| 207Q00000X Family Medicine (Licence: NC 2019-01142) | |
| Enumeration Date | 2009-06-21 |
| Last Update Date | 2023-02-16 |