| NPI | 1376650572 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RS0010X Internal Medicine, Sports Medicine (Licence: WI 49282) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 49282-021) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: WI 49282-21) | |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2022-07-21 |