| NPI | 1790858462 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 49465) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: FL 161184) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: WI 49929) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: AZ 49465) | |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2023-07-12 |