| NPI | 1790078624 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301098317) |
| Additional Taxonomies | 207RS0010X Internal Medicine Sports Medicine (Licence: MI 4301098317) |
| 208000000X Pediatrics (Licence: MI 4301098317) | |
| Enumeration Date | 2011-05-25 |
| Last Update Date | 2020-03-06 |