| NPI | 1891040630 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WY 032-T2) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 293430) |
| Enumeration Date | 2012-07-18 |
| Last Update Date | 2023-07-03 |