| NPI | 1871727438 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: NY 260548) |
| Additional Taxonomies | 282NC2000X General Acute Care Hospital, Children (Licence: NY 260548) |
| Enumeration Date | 2009-05-12 |
| Last Update Date | 2016-07-19 |