| NPI | 1295265593 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: TX T9197) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME144828) |
| 208000000X Pediatrics (Licence: TX T9197) | |
| Enumeration Date | 2017-06-19 |
| Last Update Date | 2025-10-21 |