| NPI | 1063579704 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX M2584) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 1881) |
| 207Q00000X Family Medicine (Licence: KY TP024) | |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2023-03-07 |