| 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 |