NPI | 1063826972 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: FL ME144784) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME144784) |
207QS0010X Family Medicine, Sports Medicine (Licence: PA MD465845) | |
Enumeration Date | 2014-06-18 |
Last Update Date | 2023-11-01 |