| NPI | 1962063297 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: NE 33207) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 33207) |
| Enumeration Date | 2019-06-26 |
| Last Update Date | 2023-08-02 |