| NPI | 1922746551 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 33963301) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 1024960) |
| Enumeration Date | 2022-05-24 |
| Last Update Date | 2025-10-16 |