| NPI | 1992091060 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 260593) |
| Additional Taxonomies | 261QP2300X Clinic/Center Primary Care (Licence: NY 260593) |
| Enumeration Date | 2011-06-27 |
| Last Update Date | 2022-01-31 |