| NPI | 1215490776 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: GA 98198) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL OS18839) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: IL 036.162581) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL UO7417) | |
| Enumeration Date | 2019-04-11 |
| Last Update Date | 2024-05-17 |