| NPI | 1558715896 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: SC 82428) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 82428) |
| 207Q00000X Family Medicine (Licence: FL TRN22658) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: SC 20-82428) | |
| Enumeration Date | 2016-04-22 |
| Last Update Date | 2022-07-12 |