| NPI | 1770843666 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine (Licence: WA MD61422535) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD61422535) |
| Enumeration Date | 2012-05-24 |
| Last Update Date | 2023-09-28 |