| NPI | 1023122611 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: UT 5614879-1205) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 5614879-1205) |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2018-12-12 |