NPI | 1609135508 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: DE C2-0012289) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: DE C2-0012289) |
207Q00000X Family Medicine (Licence: PA OS018097) | |
207QS0010X Family Medicine, Sports Medicine (Licence: PA OS018097) | |
Enumeration Date | 2012-05-11 |
Last Update Date | 2017-08-22 |