| NPI | 1104802040 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine (Licence: PA MD052068L) |
| Additional Taxonomies | 207QS0010X Family Medicine Sports Medicine (Licence: NH 13762) |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2017-03-24 |