| NPI | 1871026799 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: MA T291487) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 258887) |
| 207Q00000X Family Medicine (Licence: VA 0101266100) | |
| 207Q00000X Family Medicine (Licence: NC 2021-00696) | |
| Enumeration Date | 2017-04-07 |
| Last Update Date | 2022-05-03 |