| NPI | 1972799062 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 65930) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 065930) |
| 207Q00000X Family Medicine (Licence: NJ 25ma08312000) | |
| Enumeration Date | 2007-09-21 |
| Last Update Date | 2022-01-07 |