| NPI | 1811213051 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 277725-1) |
| Additional Taxonomies | 208600000X Surgery (Licence: NV 15756) |
| 207Q00000X Family Medicine (Licence: NY 277725-1) | |
| Enumeration Date | 2010-04-13 |
| Last Update Date | 2016-11-15 |