| NPI | 1861755506 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MB09550200) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX R9989) |
| Enumeration Date | 2012-06-18 |
| Last Update Date | 2023-01-18 |