| NPI | 1790065399 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: OK 5482) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 172613) |
| Enumeration Date | 2011-08-26 |
| Last Update Date | 2018-11-01 |