| NPI | 1770155251 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: KS 94-11712) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: TX W1385) |
| Enumeration Date | 2021-07-14 |
| Last Update Date | 2025-09-30 |