| NPI | 1164748166 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2014-01696) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125-058918) |
| 207Q00000X Family Medicine (Licence: WI 60733-20) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: WI 60733) | |
| Enumeration Date | 2010-04-15 |
| Last Update Date | 2014-08-06 |