NPI | 1407210446 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine (Licence: UT 10490165-1205) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 10490165-1205) |
Enumeration Date | 2016-04-06 |
Last Update Date | 2023-07-03 |