| NPI | 1003032202 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: SC 35031)  | 
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: SC 35031)  | 
| 208100000X Physical Medicine & Rehabilitation (Licence: LA 204632)  | |
| 208100000X Physical Medicine & Rehabilitation (Licence: SC 35031)  | |
| Enumeration Date | 2007-04-17 | 
| Last Update Date | 2022-10-20 |