| NPI | 1902132814 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 64689) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MA08643500) |
| Enumeration Date | 2009-10-28 |
| Last Update Date | 2020-09-14 |