| NPI | 1821238171 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine (Licence: AZ 57360) |
| Additional Taxonomies | 207QS0010X Family Medicine Sports Medicine (Licence: HI 16920) |
| 207Q00000X Family Medicine (Licence: OH 57.013093) | |
| Enumeration Date | 2009-02-26 |
| Last Update Date | 2020-03-26 |