| NPI | 1104071588 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: CO DR.0065137) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: OH 35-096937) |
| Enumeration Date | 2008-11-26 |
| Last Update Date | 2021-02-02 |