| NPI | 1528358793 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: OR DO202805) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 901659) |
| 207Q00000X Family Medicine (Licence: NJ 25MB09496200) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: NJ 25MB09496200) | |
| Enumeration Date | 2011-04-08 |
| Last Update Date | 2023-05-16 |