| NPI | 1174911630 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: RI AT00331) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: ME AT441) |
| Enumeration Date | 2015-01-06 |
| Last Update Date | 2015-01-06 |