| NPI | 1649739814 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: MS 31771) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: TX S9828) |
| Enumeration Date | 2019-03-18 |
| Last Update Date | 2024-02-13 |