| NPI | 1962485573 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NH 22230) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 290725) |
| Enumeration Date | 2005-11-29 |
| Last Update Date | 2022-02-25 |