| NPI | 1386221844 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: MS 35673) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: AL 3818) |
| Enumeration Date | 2021-03-29 |
| Last Update Date | 2025-09-24 |