| NPI | 1871850081 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 5824) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 272864) |
| Enumeration Date | 2012-04-12 |
| Last Update Date | 2019-10-04 |