| NPI | 1891862090 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: PA OS008700L) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: NJ 25MB06304700) |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2015-05-20 |