| NPI | 1114379872 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: NE 2258) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA DO-05227) |
| 207Q00000X Family Medicine (Licence: IA R10715) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: KS 94-10056) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: IA DO-05227) | |
| Enumeration Date | 2016-07-06 |
| Last Update Date | 2022-06-23 |