| NPI | 1235490608 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102204160) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: WV 2990) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: VA 0102204160) | |
| Enumeration Date | 2012-06-01 |
| Last Update Date | 2020-12-09 |