| NPI | 1821518135 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 310290) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301112469) |
| Enumeration Date | 2017-06-27 |
| Last Update Date | 2026-07-28 |