| NPI | 1891345302 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 321973) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL 165854) |
| Enumeration Date | 2019-09-17 |
| Last Update Date | 2025-09-13 |