| NPI | 1912201062 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD153148) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 227422) |
| Enumeration Date | 2011-01-04 |
| Last Update Date | 2020-07-31 |