| NPI | 1306318340 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 56761) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VT 042.0013914) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: AZ 56761) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: VT 042.0013914) | |
| 207Q00000X Family Medicine (Licence: ZZ 101037) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: ZZ 101037) | |
| Enumeration Date | 2018-12-31 |
| Last Update Date | 2019-04-10 |