| NPI | 1891149555 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine (Licence: MA 284784) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 284764) |
| Enumeration Date | 2016-04-19 |
| Last Update Date | 2020-12-18 |