| NPI | 1750762027 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: NJ 25MB11321900) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: PA 25MB11321900) |
| Enumeration Date | 2015-06-12 |
| Last Update Date | 2024-04-25 |