| NPI | 1336668763 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: FL ME141195) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 8587) |
| Enumeration Date | 2017-09-18 |
| Last Update Date | 2021-03-01 |