| NPI | 1295233997 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation Sports Medicine (Licence: AZ 7105) |
| Additional Taxonomies | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: AZ 7105) |
| 363AM0700X Physician Assistant Medical (Licence: AZ 7105) | |
| Enumeration Date | 2018-01-28 |
| Last Update Date | 2018-06-07 |