| NPI | 1861059602 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: MO 2024012283) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2024012283) |
| Enumeration Date | 2019-05-28 |
| Last Update Date | 2025-09-11 |