NPI | 1972165959 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 318240) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT019635) |
Enumeration Date | 2019-07-01 |
Last Update Date | 2025-05-15 |