NPI | 1508386871 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine (Licence: VA 0101265749) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101265749) |
Enumeration Date | 2017-06-27 |
Last Update Date | 2022-12-09 |