| NPI | 1932353315 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 52283) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 32903) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: SC 32903) | |
| Enumeration Date | 2008-11-11 |
| Last Update Date | 2019-03-13 |