| NPI | 1124312137 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: NH 20479) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: VA 0101258613) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: PA MD451226) | |
| Enumeration Date | 2011-06-07 |
| Last Update Date | 2020-05-18 |