| NPI | 1528640554 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: LA 341112) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA 341112) |
| Enumeration Date | 2021-04-28 |
| Last Update Date | 2025-08-11 |