| NPI | 1043660178 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: TX S5816) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX S5816) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-06-20 |
| Last Update Date | 2021-08-25 |