| NPI | 1497049605 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 89706) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: PA MD453448) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: TX Q5522) | |
| Enumeration Date | 2011-06-06 |
| Last Update Date | 2022-04-12 |