| NPI | 1619462173 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine (Licence: AZ 67050) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301114977) |
| Enumeration Date | 2018-06-27 |
| Last Update Date | 2022-08-16 |