| NPI | 1629377411 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: KY 03699) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: OH 34.011667) |
| Enumeration Date | 2011-03-20 |
| Last Update Date | 2021-07-09 |