| NPI | 1972509420 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 335508) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 052321) |
| Enumeration Date | 2005-06-21 |
| Last Update Date | 2025-09-17 |