| NPI | 1669649521 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME154829) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: PR 016250) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: IL 036119539) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: OH 092606) | |
| Enumeration Date | 2008-05-09 |
| Last Update Date | 2024-11-26 |