| NPI | 1548608326 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: NE 1299) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 1299) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: KS 05-38852) | |
| Enumeration Date | 2013-06-13 |
| Last Update Date | 2022-12-20 |