| NPI | 1629394804 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080S0010X Pediatrics Sports Medicine (Licence: FL OS15079) |
| Additional Taxonomies | 2080S0010X Pediatrics Sports Medicine (Licence: MA 255244) |
| 2080S0010X Pediatrics Sports Medicine (Licence: GA 72298) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-04-13 |
| Last Update Date | 2018-05-02 |