| NPI | 1538452966 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: RI MD15220) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301098575) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301098575) | |
| Enumeration Date | 2011-05-18 |
| Last Update Date | 2016-10-07 |