| NPI | 1184129751 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine (Licence: NY 313997) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 313997) |
| Enumeration Date | 2018-03-27 |
| Last Update Date | 2022-10-25 |