| NPI | 1972701019 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: KS 04-36559) |
| Additional Taxonomies | 174400000X Specialist (Licence: MO 2013021430) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: MO 2013021430) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: KS 04-36559) | |
| Enumeration Date | 2007-07-10 |
| Last Update Date | 2019-06-01 |