| NPI | 1477520963 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: SC 81863) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 81883) |
| 207Q00000X Family Medicine (Licence: MI 4301081245) | |
| Enumeration Date | 2006-03-02 |
| Last Update Date | 2021-06-02 |