| NPI | 1417210790 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RS0010X Internal Medicine, Sports Medicine (Licence: MN 75542) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX S9140) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: TX S9140) | |
| Enumeration Date | 2012-06-21 |
| Last Update Date | 2024-05-10 |