| NPI | 1942629266 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine (Licence: KS 05-40942) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 05-40942) |
| 207QA0505X Family Medicine Adult Medicine (Licence: MO 2015036405) | |
| Enumeration Date | 2014-04-15 |
| Last Update Date | 2025-04-01 |