NPI | 1831625805 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: FL OS15631) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5101025655) |
Enumeration Date | 2017-05-11 |
Last Update Date | 2023-09-25 |