| NPI | 1558587519 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: TX M1285) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: CA G74916) |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2011-09-01 |