| NPI | 1275067605 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine (Licence: NC 2022026666) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2022026666) |
| 207QS0010X Family Medicine Sports Medicine (Licence: OR DO205686) | |
| Enumeration Date | 2017-04-12 |
| Last Update Date | 2023-12-27 |