| NPI | 1083234496 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: MI 4301512851) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125075664) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: NC 2023-01571) | |
| 207Q00000X Family Medicine (Licence: MI 4301512851) | |
| Enumeration Date | 2020-04-26 |
| Last Update Date | 2025-09-03 |