| NPI | 1003819509 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MS 19888) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX L2954) |
| Enumeration Date | 2005-05-27 |
| Last Update Date | 2015-03-31 |