| NPI | 1902024714 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 5101016866) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: MI 5101016866) |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2021-03-10 |