| NPI | 1952660599 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: CA 20A15521) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: CA 20A15521) |
| Enumeration Date | 2012-05-15 |
| Last Update Date | 2019-12-09 |