| NPI | 1497173991 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: NY 318684) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: WA MD60858540) |
| Enumeration Date | 2014-04-01 |
| Last Update Date | 2022-10-03 |