| NPI | 1679984181 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: TX 582094) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10049286) |
| Enumeration Date | 2014-05-19 |
| Last Update Date | 2022-07-21 |