| NPI | 1073654091 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2009010248) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 41797) |
| 207QS0010X Family Medicine Sports Medicine (Licence: MO 2009010248) | |
| Enumeration Date | 2007-02-11 |
| Last Update Date | 2021-02-19 |