| NPI | 1609508167 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: MS 34179) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: AL DO4260) |
| 207Q00000X Family Medicine (Licence: AL DO4260) | |
| Enumeration Date | 2022-06-24 |
| Last Update Date | 2026-07-08 |