| NPI | 1881858439 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: MN 54413) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 51422) |
| Enumeration Date | 2008-07-14 |
| Last Update Date | 2019-05-06 |