| NPI | 1962080226 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine (Licence: PA MD483396) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207QS0010X Family Medicine Sports Medicine (Licence: PA MT222323) | |
| Enumeration Date | 2021-03-30 |
| Last Update Date | 2025-09-04 |