| NPI | 1982051660 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: VA 0102205725) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0102205725) |
| 207Q00000X Family Medicine (Licence: MI 5101022404) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-05-23 |
| Last Update Date | 2020-01-13 |