| NPI | 1609900893 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: OR 27601) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: SC 28751) |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2020-07-27 |