| NPI | 1073617429 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine (Licence: NH 14555) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101240554) |
| Enumeration Date | 2006-09-07 |
| Last Update Date | 2012-02-03 |