| NPI | 1891054128 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: MA 266645) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 123112) |
| 207R00000X Internal Medicine (Licence: MA 266645) | |
| 208000000X Pediatrics (Licence: MA 266645) | |
| Enumeration Date | 2012-05-07 |
| Last Update Date | 2019-05-02 |