| NPI | 1073956363 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: TN 59835) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: WI 075833) |
| Enumeration Date | 2013-04-17 |
| Last Update Date | 2024-06-12 |