| NPI | 1992757322 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: NC 201201008) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO MD113191) |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2022-07-21 |