| NPI | 1366647000 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME102446) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101256131) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: FL ME102446) | |
| Enumeration Date | 2007-06-20 |
| Last Update Date | 2020-04-15 |