| NPI | 1275694408 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: MD D64869) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: KY TP786) |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2012-03-29 |