| NPI | 1568759041 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: NY 280850) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 280850) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-07-05 |
| Last Update Date | 2026-01-16 |