| NPI | 1265637649 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: CO 50868) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101243937) |
| Enumeration Date | 2007-06-18 |
| Last Update Date | 2023-08-04 |