| NPI | 1972759207 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 250581) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY ag3434901045) |
| Enumeration Date | 2008-08-18 |
| Last Update Date | 2018-03-21 |