| NPI | 1932674496 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 94-12635) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: KS 24-01107) |
| Enumeration Date | 2018-10-10 |
| Last Update Date | 2026-05-24 |