| NPI | 1194468801 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: MI 5101028735) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5101028735) |
| Enumeration Date | 2022-04-20 |
| Last Update Date | 2025-08-26 |