| NPI | 1912388760 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CT 66895) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 286921) |
| 207Q00000X Family Medicine (Licence: RI MD16214) | |
| Enumeration Date | 2015-06-17 |
| Last Update Date | 2022-03-07 |