| NPI | 1467983759 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: NC 2020-04067) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD473487) |
| 207Q00000X Family Medicine (Licence: NC 2020-04067) | |
| Enumeration Date | 2017-03-27 |
| Last Update Date | 2024-03-08 |