| NPI | 1083845036 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: LA DO.000291) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 102202830) |
| 207Q00000X Family Medicine (Licence: OK 4734) | |
| 207Q00000X Family Medicine (Licence: WV 2548) | |
| Enumeration Date | 2009-08-06 |
| Last Update Date | 2016-11-29 |