| NPI | 1922288802 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine (Licence: CA 20A10913) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 4720) |
| Enumeration Date | 2007-11-08 |
| Last Update Date | 2020-04-10 |