| NPI | 1073808275 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: NC 2012-01858) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2012-01858) |
| Enumeration Date | 2011-06-15 |
| Last Update Date | 2026-05-07 |