| NPI | 1396302246 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: LA 330804) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA 330804) |
| 207Q00000X Family Medicine (Licence: GA 1396302246) | |
| 207Q00000X Family Medicine (Licence: GA 10950) | |
| Enumeration Date | 2019-05-28 |
| Last Update Date | 2023-11-08 |