| NPI | 1720648058 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: NE 2348) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 8565) |
| 207Q00000X Family Medicine (Licence: NE 2348) | |
| Enumeration Date | 2019-06-18 |
| Last Update Date | 2024-05-29 |