| NPI | 1194842484 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine (Licence: CO 0055898) |
| Additional Taxonomies | 207QS0010X Family Medicine Sports Medicine (Licence: MA 259757) |
| 207Q00000X Family Medicine (Licence: PA OS013618) | |
| Enumeration Date | 2007-03-23 |
| Last Update Date | 2021-05-04 |