| NPI | 1124194592 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301077495) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: MI 4301077495) |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2007-07-08 |