| NPI | 1073716635 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101247305) |
| Additional Taxonomies | 207QS0010X Family Medicine Sports Medicine (Licence: VA 0101247305) |
| Enumeration Date | 2007-06-08 |
| Last Update Date | 2023-08-11 |