| NPI | 1841212271 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: NC 2002-01254) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX M1724) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: TX M1724) | |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2018-03-19 |