NPI | 1275278194 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 5101028588) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX V0246) |
207QS0010X Family Medicine, Sports Medicine (Licence: MI 5101028588) | |
Enumeration Date | 2022-05-04 |
Last Update Date | 2025-07-02 |