| NPI | 1316649882 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: MI 4350150553) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4350150553) |
| Enumeration Date | 2023-03-20 |
| Last Update Date | 2026-06-12 |