| NPI | 1063187805 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX W7301) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NY 0) |
| Enumeration Date | 2021-08-13 |
| Last Update Date | 2026-07-10 |