| NPI | 1851528616 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 202K00000X (Licence: NJ 25MA09058000) |
| Additional Taxonomies | 202K00000X (Licence: FL ME108323) |
| 2083S0010X Preventive Medicine, Sports Medicine (Licence: NJ 25MA09058000) | |
| 2083S0010X Preventive Medicine, Sports Medicine (Licence: FL ME108323) | |
| 208600000X Surgery (Licence: FL ME108323) | |
| 208600000X Surgery (Licence: NJ 25MA09058000) | |
| Enumeration Date | 2009-06-18 |
| Last Update Date | 2018-03-17 |