| NPI | 1851822704 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: NY 295495-1) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ME141083) |
| Enumeration Date | 2017-03-22 |
| Last Update Date | 2021-07-01 |