| NPI | 1073809141 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2015026147) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036159591) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: IL 036159591) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: OH 123806) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: MO 2015026147) | |
| Enumeration Date | 2011-06-27 |
| Last Update Date | 2025-01-28 |