| NPI | 1912052895 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 252280) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 225344) |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2014-02-19 |