| NPI | 1104112168 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: PA OS016358) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS016358) |
| Enumeration Date | 2011-06-28 |
| Last Update Date | 2019-09-18 |