| NPI | 1629094040 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 97-01472) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: NC 97-01472) |
| Enumeration Date | 2006-07-15 |
| Last Update Date | 2018-04-16 |