| NPI | 1164553426 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: NJ 25MA06838400) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ MA068384) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: PA MD0441103) | |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2019-05-22 |