| NPI | 1902218944 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101256459) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 267-601-1) |
| Enumeration Date | 2014-05-26 |
| Last Update Date | 2024-07-23 |