| NPI | 1053430462 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2020-04516) |
| Additional Taxonomies | 207QS0010X Family Medicine Sports Medicine (Licence: TN 43965) |
| 207Q00000X Family Medicine (Licence: TN 43965) | |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2021-03-25 |