| NPI | 1952388563 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 5101012829) |
| Additional Taxonomies | 207QS0010X Family Medicine Sports Medicine (Licence: MI 5101012829) |
| Enumeration Date | 2005-12-23 |
| Last Update Date | 2018-05-15 |