| NPI | 1508179854 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: ND 13097) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SD 9080) |
| 207Q00000X Family Medicine (Licence: ND PT 13097) | |
| 207Q00000X Family Medicine (Licence: ND 13097) | |
| Enumeration Date | 2010-07-15 |
| Last Update Date | 2019-12-19 |