| NPI | 1588622963 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: GA 079844) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 35591) |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2018-05-01 |