| NPI | 1902166978 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: WI 70079-20) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: AZ 50450) |
| Enumeration Date | 2012-05-23 |
| Last Update Date | 2024-02-26 |