| NPI | 1174217095 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: WI 87467-20) |
| Additional Taxonomies | 2080S0010X Pediatrics, Sports Medicine (Licence: WI 87467-20) |
| Enumeration Date | 2023-06-05 |
| Last Update Date | 2026-07-07 |