| NPI | 1205937992 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 200400405) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: NC 2004-00405) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2021-08-10 |