| NPI | 1518304211 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: PA OS018589) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT015214) |
| Enumeration Date | 2013-06-04 |
| Last Update Date | 2022-07-21 |