| NPI | 1912926486 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301091353) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 224994) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2012-09-12 |