| NPI | 1700025012 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME105009) |
| Additional Taxonomies | 207QS0010X Family Medicine Sports Medicine (Licence: IL 036.127405) |
| Enumeration Date | 2009-02-10 |
| Last Update Date | 2019-10-03 |