| NPI | 1285735993 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine (Licence: WI 30492) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 30492) |
| 207RS0010X Internal Medicine Sports Medicine (Licence: WI 30492) | |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2025-05-12 |