| NPI | 1811578552 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: TN 74600) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 74600) |
| 207Q00000X Family Medicine (Licence: SC 91891) | |
| Enumeration Date | 2021-04-15 |
| Last Update Date | 2025-10-09 |