| NPI | 1487861076 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: FL ME111472) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX P5310) |
| 207Q00000X Family Medicine (Licence: FL ME111472) | |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2016-09-08 |