| NPI | 1992185011 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine (Licence: VA 0101266602) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME129819) |
| 207Q00000X Family Medicine (Licence: FL 21807) | |
| Enumeration Date | 2015-06-03 |
| Last Update Date | 2019-10-25 |