| NPI | 1033317581 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine (Licence: NC 2019-02317) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD439287) |
| Enumeration Date | 2007-07-06 |
| Last Update Date | 2020-12-18 |