| NPI | 1629426028 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: TX S9777) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: FL OS16539) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA OT017151) | |
| Enumeration Date | 2016-05-26 |
| Last Update Date | 2021-05-26 |