| NPI | 1912299132 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD172943) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 275790-1) |
| Enumeration Date | 2011-05-05 |
| Last Update Date | 2020-02-11 |