| NPI | 1932163201 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 54623) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 48204) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: KY 54623) | |
| Enumeration Date | 2006-04-13 |
| Last Update Date | 2021-01-14 |