| NPI | 1952988560 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: UT 14235289-1204) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO DR.0069496) |
| Enumeration Date | 2021-03-28 |
| Last Update Date | 2025-12-01 |