| NPI | 1366854499 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: CT 61755) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CT 61755) |
| Enumeration Date | 2014-05-23 |
| Last Update Date | 2020-06-11 |