| NPI | 1801011440 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 47485) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2009007059) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: KY 47485) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: MO 2009007059) | |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2017-12-18 |