| NPI | 1043879943 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX T5882) | 
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP100069233) | 
| Enumeration Date | 2019-06-13 | 
| Last Update Date | 2025-04-09 |