| NPI | 1265793616 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: GA 78910) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 078910) |
| Enumeration Date | 2012-06-01 |
| Last Update Date | 2022-07-21 |