| NPI | 1982197026 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: FL ME141949) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 301996) |
| 207Q00000X Family Medicine (Licence: FL ME141949) | |
| Enumeration Date | 2018-06-13 |
| Last Update Date | 2026-01-12 |