| NPI | 1104080050 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: VA 0102204185) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: MD H0076278) |
| Enumeration Date | 2008-07-10 |
| Last Update Date | 2021-07-22 |