| NPI | 1215565411 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: IA R-12973) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 30802) |
| 207Q00000X Family Medicine (Licence: MN 69720) | |
| Enumeration Date | 2020-04-01 |
| Last Update Date | 2023-06-20 |