| NPI | 1932336542 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 36544) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2016-02043) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: SC 36544) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: NC 2016-02043) | |
| Enumeration Date | 2009-06-22 |
| Last Update Date | 2017-06-05 |