| NPI | 1801982749 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD185352) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA 00048866) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: HI 10509) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: WA 00048866) | |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2021-03-25 |