| NPI | 1982915930 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: NY P75910) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY P75910) |
| Enumeration Date | 2010-06-24 |
| Last Update Date | 2016-03-24 |