| NPI | 1962777326 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: OH 011843) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A12937) |
| Enumeration Date | 2012-03-19 |
| Last Update Date | 2022-02-04 |