| NPI | 1124186101 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A14188) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer |
| 207Q00000X Family Medicine (Licence: MI 5101018623) | |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2016-03-11 |